Too much $$$?

[Winkledorf]

I am currently pursuing healthcare-related degree, but didn't really want to go into the field although quite a bit of money has now been spent on my education. What I really wanted was to get an M.D. or D.O., and had everything all set up to go into either when some unexpected life events happened that derailed my track.

My question is do you think it is totally impossible to pursue this track if it means my end-of-school federal debt would be around $470k, or is this potentially something I could do? My dream was always to become a physician and it's really the only thing I see myself happy doing (I shadowed a surgeon for almost a year and absolutely love it), but it would be very difficult to justify "pursuing my dreams" for this price when I do have a very young family to take care of. My family's on board, since they want me to be happy, but I don't want to put my wife's/kids' futures in a bad position. I think I would be successful and match somewhere from IM at the minimum to something more specialized. The school I would go to would be a state M.D. program (getting in is not the problem - the cost is the reason I haven't made the switch). I think D.O. programs are generally more expensive, so I thought maybe you guys might have a better perspective than me on the implications of that amount of debt. Any useful advice is appreciated.

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[TheWeeIceMan]

For the most part, this is going to come down to a personal decision for you and your family. Can you pursue medicine with a pricetag of 470k? Yeah, you probably can. The question is going to be your family's tolerance (and yours) for living on a pretty tight budget for years to come. I don't know if your wife works, but those years in med school and residency/fellowship will be pretty lean. Paying back that 470k (will be a lot more with interest), is going to be a real pain. However, you can go on PAYE, which caps the amount you pay in relations to your "disposable" income and still live a pretty solid middle class (maybe upper middle) life at some point after you get that first attending job.

I guess my point is, that you can make it work, but it will mean enduring years of living a very frugal lifestyle before you can see the returns on your education. If you and your family know that going in, and are cool with it, then I think it's something you could do.

 

[Winkledorf]

For the most part, this is going to come down to a personal decision for you and your family. Can you pursue medicine with a pricetag of 470k? Yeah, you probably can. The question is going to be your family's tolerance (and yours) for living on a pretty tight budget for years to come. I don't know if your wife works, but those years in med school and residency/fellowship will be pretty lean. Paying back that 470k (will be a lot more with interest), is going to be a real pain. However, you can go on PAYE, which caps the amount you pay in relations to your "disposable" income and still live a pretty solid middle class (maybe upper middle) life at some point after you get that first attending job.

I guess my point is, that you can make it work, but it will mean enduring years of living a very frugal lifestyle before you can see the returns on your education. If you and your family know that going in, and are cool with it, then I think it's something you could do.

Thank you very much for the reply. I am inclined to go for it, but I do really need to make sure we can budget accordingly, especially for the leanest years.

 

[koan]

My question is do you think it is totally impossible to pursue this track if it means my end-of-school federal debt would be around $470k, or is this potentially something I could do?

Why would it be impossible? You have access to loan repayment calculators. At 7.5% interest (a mix of Stafford at 6.8% and Plus at 7.9%) and assuming you'll need to defer payments during residency to support your family, your "end-of-school" debt could be well north of $500k. If you entered PAYE at that point your monthly payments are capped at 10% of discretionary income (which is salary - 150% of the poverty line). On an IM hospitalist salary of $250k, your payments would start at about $1900/month. There is currently a 20-year consecutive payment forgiveness of remaining balance, but who knows if it will persist by that time. Over that period (20 yrs) you might pay a total of $350k interest and a final amount of $850k. You'll have earned $250k x 20 years or $5M without including normal salary increase or adjusting for inflation. Can your other health profession match that earning power? Don't forget about the lost potential income of ~7 years for school and residency.

My dream was always to become a physician and it's really the only thing I see myself happy doing (I shadowed a surgeon for almost a year and absolutely love it), but it would be very difficult to justify "pursuing my dreams" for this price when I do have a very young family to take care of. My family's on board, since they want me to be happy, but I don't want to put my wife's/kids' futures in a bad position.

This is a personal and family decision. Soul searching, discussions with extended family, getting people on board to help with child care if needed, a willingness to rent instead of own, deferring vacations, lost time that could be spent with your kids, stress, the ever present possibility that things could "derail" your track during med school / residency. Is all of this worth it? Probably not for the money alone, but for pursuing your dreams maybe.

I think I would be successful and match somewhere from IM at the minimum to something more specialized. The school I would go to would be a state M.D. program (getting in is not the problem - the cost is the reason I haven't made the switch).

Lots of assumptions here. Maybe you have incredible stats or an inside track to this program, but nothing is ever certain. Matching IM anywhere isn't hard, but what about matching near family, in a nice city, at a University program with good fellowship options?

 

[Winkledorf]

Why would it be impossible? You have access to loan repayment calculators. At 7.5% interest (a mix of Stafford at 6.8% and Plus at 7.9%) and assuming you'll need to defer payments during residency to support your family, your "end-of-school" debt could be well north of $500k. If you entered PAYE at that point your monthly payments are capped at 10% of discretionary income (which is salary - 150% of the poverty line). On an IM hospitalist salary of $250k, your payments would start at about $1900/month. There is currently a 20-year consecutive payment forgiveness of remaining balance, but who knows if it will persist by that time. Over that period (20 yrs) you might pay a total of $350k interest and a final amount of $850k. You'll have earned $250k x 20 years or $5M without including normal salary increase or adjusting for inflation. Can your other health profession match that earning power? Don't forget about the lost potential income of ~7 years for school and residency.



This is a personal and family decision. Soul searching, discussions with extended family, getting people on board to help with child care if needed, a willingness to rent instead of own, deferring vacations, lost time that could be spent with your kids, stress, the ever present possibility that things could "derail" your track during med school / residency. Is all of this worth it? Probably not for the money alone, but for pursuing your dreams maybe.



Lots of assumptions here. Maybe you have incredible stats or an inside track to this program, but nothing is ever certain. Matching IM anywhere isn't hard, but what about matching near family, in a nice city, at a University program with good fellowship options?

Thanks for the reply. I didn't realize about the -150% poverty level for the discretionary income calculation. Also good to recognize the capitalized interest I hadn't included in my projection. Current course can match and exceed the $250k projection within what would be my residency period for medicine - but as I said, I didn't want my present course, which worries me (though I can continue out of obligation if switching breaks the bank too badly).

 

[TheWeeIceMan]

Why would it be impossible? You have access to loan repayment calculators. At 7.5% interest (a mix of Stafford at 6.8% and Plus at 7.9%) and assuming you'll need to defer payments during residency to support your family, your "end-of-school" debt could be well north of $500k. If you entered PAYE at that point your monthly payments are capped at 10% of discretionary income (which is salary - 150% of the poverty line). On an IM hospitalist salary of $250k, your payments would start at about $1900/month. There is currently a 20-year consecutive payment forgiveness of remaining balance, but who knows if it will persist by that time. Over that period (20 yrs) you might pay a total of $350k interest and a final amount of $850k. You'll have earned $250k x 20 years or $5M without including normal salary increase or adjusting for inflation. Can your other health profession match that earning power? Don't forget about the lost potential income of ~7 years for school and residency.

Don't forget taxes.

 

[madsciencegrrl]

So I posted in the allopathic forum and didn't get any insight. Maybe you guys could help me out?

I am currently pursuing another health profession degree, but didn't really want to go into the field although quite a bit of money has now been spent on my education. What I really wanted was to get an M.D. or D.O., and had everything all set up to go into either when some unexpected life events happened that derailed my track.

My question is do you think it is totally impossible to pursue this track if it means my end-of-school federal debt would be around $470k, or is this potentially something I could do? My dream was always to become a physician and it's really the only thing I see myself happy doing (I shadowed a surgeon for almost a year and absolutely love it), but it would be very difficult to justify "pursuing my dreams" for this price when I do have a very young family to take care of. My family's on board, since they want me to be happy, but I don't want to put my wife's/kids' futures in a bad position. I think I would be successful and match somewhere from IM at the minimum to something more specialized. The school I would go to would be a state M.D. program (getting in is not the problem - the cost is the reason I haven't made the switch). I think D.O. programs are generally more expensive, so I thought maybe you guys might have a better perspective than me on the implications of that amount of debt. Any useful advice is appreciated.

I am a 2nd year medical student..so I have limited knowledge right now of what it's like to pay back that amount of loans.

However, I'm a non-trad...who never made above 30k a year in her life, have enjoyed my life, and am very used to my lifestyle. I always say forget the money and do what you love, but that also comes with the responsibility to your family if you have one and other debts. I'm fine with working for a small salary until I have my student loans paid off. I have no desire to own a home for quite a while, it's a lot of work and time I won't have. I'm a happy renter who would rather put her energy into other things. But it may be important for you to own a home or maybe you already do? Even half a physician's salary is double what I've been used to my entire life. That may not apply to you though. I don't have children. I do have a decent car and a few small bills but nothing that won't be paid off before I graduate school anyway.

What helps me is writing out my future goals...in order of importance to me. This also includes how career focused I want my life to be. If your life is all about the time spent not in a job then it may not matter what your profession is and I would do what's likely to net you more free time. But if you are very career focused...and enjoy(even sometimes when you don't realize it) placing a lot of time and effort into a career then you will do that no matter what the career is so it would be best to do what you love rather then for money since a considerable amount of your life will be spent there. If all that makes any sense. =)

The other thing to consider with already a large loan burden is your eligibility to continue to borrow. You may want to make sure you have not reached any of the borrowing limits.

In the end....if you are fine with a smaller income and devoting more to paying back your loans I say go for it. Income satisfaction is purely subjective to the type of lifestyle and responsibilities you have accrued. From my experience, I've always had what I needed, been able to do things I like to do...because I learned from a very young age how to handle a small income and it's not so bad. Problems come when people grew up with or are used to luxuries...it's hard to pull away from that lifestyle once you are immersed in it so then income to them is more important or same if you are the provider for a family.

Hope my perspective helps.

 

[Winkledorf]

I am a 2nd year medical student..so I have limited knowledge right now of what it's like to pay back that amount of loans.

However, I'm a non-trad...who never made above 30k a year in her life, have enjoyed my life, and am very used to my lifestyle. I always say forget the money and do what you love, but that also comes with the responsibility to your family if you have one and other debts. I'm fine with working for a small salary until I have my student loans paid off. I have no desire to own a home for quite a while, it's a lot of work and time I won't have. I'm a happy renter who would rather put her energy into other things. But it may be important for you to own a home or maybe you already do? Even half a physician's salary is double what I've been used to my entire life. That may not apply to you though. I don't have children. I do have a decent car and a few small bills but nothing that won't be paid off before I graduate school anyway.

What helps me is writing out my future goals...in order of importance to me. This also includes how career focused I want my life to be. If your life is all about the time spent not in a job then it may not matter what your profession is and I would do what's likely to net you more free time. But if you are very career focused...and enjoy(even sometimes when you don't realize it) placing a lot of time and effort into a career then you will do that no matter what the career is so it would be best to do what you love rather then for money since a considerable amount of your life will be spent there. If all that makes any sense. =)

The other thing to consider with already a large loan burden is your eligibility to continue to borrow. You may want to make sure you have not reached any of the borrowing limits.

In the end....if you are fine with a smaller income and devoting more to paying back your loans I say go for it. Income satisfaction is purely subjective to the type of lifestyle and responsibilities you have accrued. From my experience, I've always had what I needed, been able to do things I like to do...because I learned from a very young age how to handle a small income and it's not so bad. Problems come when people grew up with or are used to luxuries...it's hard to pull away from that lifestyle once you are immersed in it so then income to them is more important or same if you are the provider for a family.

Hope my perspective helps.

Yes, very helpful, and great post. All I ever wanted to do was medicine and I'd say I'm a pretty career-driven person. I was accepted, ready to go, etc., but then some circumstances occurred that necessitated my family and I move to another state, after which I began this other career path since it was available right then (= poor judgment during a time that was very bad for us). If I were single, I would no questions have made the switch by now since I don't mind being poor for a while, but it's the increased cost of sustaining a family that's hard to do even frugally. Thanks again for your input and I will try out the priority list as I refigure our budget, as well.

 

[darklabel]

I will say, as someone looking at the same kind of debt load as you (~41k in undergrad+grad loans and high tuition school), use this calculator: https://services.aamc.org/30/first/home#.U69_2I1dVTE

Honestly, it put my mind at ease in a way because even if PAYE/IBR stops existing, I know on an extended plan I can pay off the loans and have enough left over for a middle class lifestyle. However, I wouldn't bank on the program staying around forever. The political landscape is always changing and 10 years is a long long time from now and a lot of things can change. The worst part is that IBR/PAYE isn't guaranteed in your Promissory Note. So you can be on your 24th year on IBR and if Congress decides to repeal the law (or most likely set a cap for it), then you could be left in a worse position than before.

Best advice I read is expect to live like a resident once you graduate and always minimize the amount of loans necessary during medical school.

If IBR and PAYE stayed around forever the it would be a great program, but somehow most of us doubt that and you will be hard pressed as a medical student to have anyone care about the amount of debt you will graduate with.

 

[group_theory]

Make sure your spouse is 100% behind your decision. You will need someone who is just as invested as you are in succeeding, willing to make sacrifices - not just monetary, but also emotional. There will be times you won't be available for your spouse's needs (and/or children) - either because you are busy studying (for an upcoming exam, the boards, clinical rotations, overnight calls, etc). Not knowing where you will go until the match (April of 4th year) can also take an emotional toll. Residency, with its schedules (and lack of control over when your days off will be, or the "fake" day off where you go from overnight to days, etc) can be grueling as well. So you need your spouse to be 100% behind you all the way. It's a ultramarathon, not a sprint or a half marathon.

As for money - be frugal and tight during med school years because the spending money are "loans" that have to be repaid. Your spouse will be the major breadwinner.

During residency, salaries are around $50k+ (some more, some less) ... and may slowly creep up so it may be higher by the time you are ready for residency (when I was starting medical school, residency salary was around $35-$40k, and now starting salaries are around $50k for PGY1)

Depending on where you do your residency (and type of residency), you may be able to moonlight - that can bring extra income (but also less time with family). Residents around my area moonlight for around $100/hr. Fellows moonlight at hospitals desperate for specialty coverage for around $150-$200/hr. It's an option (but again, your residency may not allow moonlighting, or there may be no need for moonlighters). Doing a 12 hr shift moonlight can make you lots of $$$ (just watch out for the tax man), but you do lose your day off (and family time) but something to consider in your overall plan.

Future income and potentials are hard to predict - there are many possibilities. One of my friends, who finished IM residency, is working 2 jobs as a hospitalist. One job is a nocturnist position at a medium size hospital where he works 7 on, 7 off, makes $240k/year. He has another part-time hospitalist job (at another hospital) where he works during the week that he is off at the other hospital - last year made around $150k (he's only part-time there). So his gross income last year was $390k. Didn't have much time off but he's happy, and most of his sizable student loans are almost paid off (as well as his wife's loans). His wife is a fellow so they both have similar hours.

So if you want to continue to work hard even after residency, then it's possible. If you want to back-off a little, you can too. It's all up to you (and your family) and priorities. But to make it to this point, there are a lot of hurdles, and lots of frugal nights (and palpitations as you see your student loan bills and the total collective amount that needs to be repaid) ... and there will be stress upon the family.

 

[Winkledorf]

I will say, as someone looking at the same kind of debt load as you (~41k in undergrad+grad loans and high tuition school), use this calculator: https://services.aamc.org/30/first/home#.U69_2I1dVTE

Honestly, it put my mind at ease in a way because even if PAYE/IBR stops existing, I know on an extended plan I can pay off the loans and have enough left over for a middle class lifestyle. However, I wouldn't bank on the program staying around forever. The political landscape is always changing and 10 years is a long long time from now and a lot of things can change. The worst part is that IBR/PAYE isn't guaranteed in your Promissory Note. So you can be on your 24th year on IBR and if Congress decides to repeal the law (or most likely set a cap for it), then you could be left in a worse position than before.

Best advice I read is expect to live like a resident once you graduate and always minimize the amount of loans necessary during medical school.

If IBR and PAYE stayed around forever the it would be a great program, but somehow most of us doubt that and you will be hard pressed as a medical student to have anyone care about the amount of debt you will graduate with.

Thanks for linking that calculator - I hadn't seen it before and it is very useful, particularly switching between the different repayment plans.

 

[Winkledorf]

Make sure your spouse is 100% behind your decision. You will need someone who is just as invested as you are in succeeding, willing to make sacrifices - not just monetary, but also emotional. There will be times you won't be available for your spouse's needs (and/or children) - either because you are busy studying (for an upcoming exam, the boards, clinical rotations, overnight calls, etc). Not knowing where you will go until the match (April of 4th year) can also take an emotional toll. Residency, with its schedules (and lack of control over when your days off will be, or the "fake" day off where you go from overnight to days, etc) can be grueling as well. So you need your spouse to be 100% behind you all the way. It's a ultramarathon, not a sprint or a half marathon.

As for money - be frugal and tight during med school years because the spending money are "loans" that have to be repaid. Your spouse will be the major breadwinner.

During residency, salaries are around $50k+ (some more, some less) ... and may slowly creep up so it may be higher by the time you are ready for residency (when I was starting medical school, residency salary was around $35-$40k, and now starting salaries are around $50k for PGY1)

Depending on where you do your residency (and type of residency), you may be able to moonlight - that can bring extra income (but also less time with family). Residents around my area moonlight for around $100/hr. Fellows moonlight at hospitals desperate for specialty coverage for around $150-$200/hr. It's an option (but again, your residency may not allow moonlighting, or there may be no need for moonlighters). Doing a 12 hr shift moonlight can make you lots of $$$ (just watch out for the tax man), but you do lose your day off (and family time) but something to consider in your overall plan.

Future income and potentials are hard to predict - there are many possibilities. One of my friends, who finished IM residency, is working 2 jobs as a hospitalist. One job is a nocturnist position at a medium size hospital where he works 7 on, 7 off, makes $240k/year. He has another part-time hospitalist job (at another hospital) where he works during the week that he is off at the other hospital - last year made around $150k (he's only part-time there). So his gross income last year was $390k. Didn't have much time off but he's happy, and most of his sizable student loans are almost paid off (as well as his wife's loans). His wife is a fellow so they both have similar hours.

So if you want to continue to work hard even after residency, then it's possible. If you want to back-off a little, you can too. It's all up to you (and your family) and priorities. But to make it to this point, there are a lot of hurdles, and lots of frugal nights (and palpitations as you see your student loan bills and the total collective amount that needs to be repaid) ... and there will be stress upon the family.

Thank you for the very realistic response - it's true that it would be more of an ultra marathon, so that's something I have to very seriously consider about the choice. Moonlighting like you said looks like it would be a possibly substantial form of income! The 100% spousal support for the decision is definitely key, though sometimes hard to gauge if she really understands how challenging this would be. Thanks again for all the input - a fellow responding obviously has been through and seen a lot already, so I'm glad to have gotten your perspective.

 

[NontradCA]

NHSC, HPSP?

 

[Winkledorf]

NHSC, HPSP?

As long as the specialty I end up in qualifies, that's probably a good source of additional repayment funds.

 

[NontradCA]

As long as the specialty I end up in qualifies, that's probably a good source of additional repayment funds.

That's not how it works. You sign up before school (or during) and they pay all tuition fees plus a generous stipend. Do a search.

 

[Winkledorf]

That's not how it works. You sign up before school (or during) and they pay all tuition fees plus a generous stipend. Do a search.

I think I'm missing where the NHSC does full tuition + stipend, plus doesn't it need to be an approved primary care specialty? The HPSP is certainly a great financial deal, though I'm not sure I'd consider going military, to be honest.

I did end up deciding the benefits don't outweigh the cost of switching in the long run, however, and that it's better not to try to take someone's spot who would be making a more favorable financial choice. Thank you again for taking the time to respond, and hopefully the advice from this thread helps someone else along the way!